4 Ways to Reduce COVID-19’s Racial Divide

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Our health care system is rife with racial and economic disparities. The National Academies’ Institute of Medicine found that “across virtually every therapeutic intervention, from the most simple medical procedure to the most complicated, blacks and other minorities receive poorer quality care and less intensive care than whites.”1 From increased rates of maternal and infant mortality to implicit bias from providers to reduced access to services and health insurance coverage, communities of color face disparities across the board.2 After centuries of structural racism and poor health outcomes, it’s no wonder that communities of color often mistrust health institutions.3

What’s even worse is that these disparities have been compounded due to the coronavirus pandemic. For example:

  • People of color are overrepresented in many of the “essential jobs,” which puts them in close contact with others who might be in poor health. For example, African Americans are overrepresented in the food service industry and transportation industries.4
  • Reduced access to paid sick leave means spreading COVID-19 is more likely. Thirty-eight percent of black Americans cannot earn a single sick day, and many fear losing their job if they miss work.5
  • Reliance on public transportation, where contracting and spreading the disease boosts COVID-19 infections. Lower-income people, black people, Latinos, and immigrants are more likely to use public transportation.6
  • Overcrowding makes the spread of COVID-19 more likely. Sixteen percent of Native American and Alaska Native families will experience overcrowding in homes compared to 2% of the total US population.7
  • Higher rates of underlying chronic health problems increase the risk of death from COVID-19. African Americans have increased rates of asthma, heart disease, and diabetes from decades of systemic discrimination.8
  • Insufficient and inappropriate information exposed communities to an increased risk of infection. Nearly 60% of black Americans live in the South, where governors from Florida, Alabama, Mississippi, and Georgia all had messaging that differed from the federal guidelines.9

The result? As small pockets of demographic data have been released, it’s more and more apparent that people of color are facing far higher rates of illness and death because of the coronavirus. In Illinois, where African Americans make up less than 15% of the population, 30% of the state’s coronavirus cases and about 40% of its coronavirus-related deaths are African Americans. In Chicago, 72% of people who have died from the coronavirus are African American.10 In Michigan, African Americans account for 14% of the population, but 40% of the state’s reported deaths. In Albany, GA, which has the highest number of deaths from the coronavirus in the state, more than 90% of the fatalities are African Americans.11 And in majority black counties, rate of infections and rate of deaths are three times higher and six times higher, respectively, than majority white counties.12

While these small datasets are revealing, the country is months into this pandemic and fewer than a dozen states have published data on race and ethnic patterns of the pandemic.13 We need data from every single state. We also need a plan to use that data and address the racial divide. Fortunately, members of Congress are shining a light on the significant impact of racial, ethnic, and income disparities. Senator Elizabeth Warren (D-MA) and 14 of her Senate colleagues and Representatives Robin Kelly (D-IL), Ayanna Pressley (D-MA), Karen Bass (D-CA), Barbara Lee (D-CA) and more than 80 of their House colleagues have introduced legislation that would require the Department of Health and Human Services (HHS) to collect COVID-19 disparities data and write a report on those disparities after this crisis. The bill also authorizes $50 million in funding for the federal government and states to conduct the data collection.14 Senator Kamala Harris (D-CA) authored a letter to Senate leadership to include policies addressing disparities in the next COVID-19 package, including coverage for treatment.15 Finally, Representative Lisa Blunt Rochester (D-DE) is drafting legislation that would go even further. Her bill would establish the necessary infrastructure to collect disparities data for COVID-19 and long into the future.

These are all important steps. In order to address the inequities amid the COVID-19 pandemic, as a nation, we must build off these efforts and take four more actions:

1. Increase the use of free mobile testing sites in low-income communities and communities of color.

From New Orleans to Detroit to Chicago, communities of color are disproportionately impacted by this virus. Instead of watching it happen to more communities, Congress should be proactive. More mobile testing sites should be targeted in those communities where access is limited and the risk of contracting the virus is high.  

2. Collect demographic data from every county, tribe, territory, and state.

Americans need to get a complete picture of how COVID-19 is affecting people of different races. To do this, the Centers for Disease Control and Prevention (CDC) should create a national database for all demographic data related to the virus, collecting data from hospitals, private and public labs, individuals, tribes, territories, electronic health records, claims data, death certificates, and private organizations.

3. Create Equity Grants to support on-the-ground efforts that reduce racial disparities.

Congress should give local entities the tools to fight racial inequality in the health care system. Congress should devote $10 billion toward Equity Grants to support hospitals, health plans, health departments, tribes, and states that are reducing health disparities during this crisis, and localities with the greatest need should have priority for these grants.

4. Create a permanent disparities database for the entire country.

Finally, Congress must ensure that public health departments and the CDC have the infrastructure to identify all types of disparities as they arise after this outbreak. It took weeks to start getting racial data during this pandemic. That would not have been the case if we had better reporting infrastructure on demographic data. States should regularly report outcomes data with specific demographic data to the CDC’s national database to prevent this lapse in the future.

To address the disparities brought to light by the coronavirus, the country needs a far better appreciation for the racial inequities in health care as well as a plan to address the issue head on. Improved data collection is only the start to a multi-faceted issue that is rooted in generations of discrimination. We need to infuse communities of color and low-income neighborhoods with far more resources and support. We need to prop up small businesses, particularly those owned by people of color. We need infrastructure projects targeted at better transportation systems, more high paying jobs, and safer housing for low-income communities and communities of color. We need to cap health care costs so no one ever goes broke from health care again. It’s time to take an equity-centric approach to this crisis.

Endnotes

  1. National Academies of Science, Engineering, and Medicine. “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.” The National Academies Press, 2003, https://www.nap.edu/catalog/10260/unequal-treatment-confronting-racial-and-ethnic-disparities-in-health-care. Accessed 13 Apr. 2020.

  2. National Academies of Science, Engineering, and Medicine. “The State of Health Disparities in the United States.” Communities in Action: Pathways to Health Equity, Baciu A, Negussie Y, Geller A, et al., The National Academies Press, 11 Jan. 2017, https://www.ncbi.nlm.nih.gov/books/NBK425844/. Accessed 13 Apr. 2020.

    Artiga, Samantha, Orgera, Kendal, and Anthony Damico. “Changes in Health Coverage by Race and Ethnicity since the ACA, 2010-2018.” Kaiser Family Foundation, 5 Mar. 2020, https://www.kff.org/disparities-policy/issue-brief/changes-in-health-coverage-by-race-and-ethnicity-since-the-aca-2010-2018/. Accessed 13 Apr. 2020.

  3. Maybank, Aletha. “The Pandemic’s Missing Data.” The New York Times, 7 Apr. 2020, https://www.nytimes.com/2020/04/07/opinion/coronavirus-blacks.html. Accessed 13 Apr. 2020.

  4. Scott, Eugene. “4 reasons coronavirus is hitting black communities so hard.” The Washington Post, 10 Apr. 2020, https://www.washingtonpost.com/politics/2020/04/10/4-reasons-coronavirus-is-hitting-black-communities-so-hard/. Accessed 10 Apr. 2020.

  5. “African Americans and Their Families Need Paid Sick Days.” National Partnership for Women and Families, Jan. 2017, https://www.nationalpartnership.org/our-work/resources/economic-justice/paid-sick-days/african-american-workers-need-paid-sick-days.pdf. Accessed 13 Apr. 2020.

  6. Anderson, Monica. “Who relies on public transit in the U.S.” Pew Research Center, 7 Apr. 2016, https://www.pewresearch.org/fact-tank/2016/04/07/who-relies-on-public-transit-in-the-u-s/. Accessed 13 Apr. 2020.

  7. Solomon, Danyelle, Maxwell, Connor, and Abril Castro. “Systemic Inequality: Displacement, Exclusion, and Segregation.” Center for American Progress, 7 Aug. 2019, https://www.americanprogress.org/issues/race/reports/2019/08/07/472617/systemic-inequality-displacement-exclusion-segregation/. Accessed 13 Apr. 2020.

  8. Calma, Justine. “American Set Up Black Communities to be Harder Hit by Covid-19.” The Verge, 8 Apr. 2020, https://www.theverge.com/2020/4/8/21213974/african-americans-covid-19-coronavirus-race-disparities. Accessed 13 Apr. 2020.

  9. Scott, Eugene. “4 reasons coronavirus is hitting black communities so hard.” The Washington Post, 10 Apr. 2020, https://www.washingtonpost.com/politics/2020/04/10/4-reasons-coronavirus-is-hitting-black-communities-so-hard/. Accessed 10 Apr. 2020.

  10. Wolfe, Jan. “African Americans more likely to die from coronavirus illness, early data shows.” Reuters, 6 Apr. 2020, https://www.reuters.com/article/us-health-coronavirus-usa-race/african-americans-more-likely-to-die-from-coronavirus-illness-early-data-shows-idUSKBN21O2B6. Accessed 13 Apr. 2020.

  11. Williams, Vanessa. “U.S. government is urged to release race, ethnicity data on covid-19 cases.The Washington Post, 6 Apr. 2020, https://www.washingtonpost.com/politics/government-urged-to-release-race-ethnicity-data-on-covid-19-cases/2020/04/06/7891aba0-7827-11ea-b6ff-597f170df8f8_story.html. Accessed 10 Apr. 2020.

  12. Scott, Eugene. “4 reasons coronavirus is hitting black communities so hard.” The Washington Post, 10 Apr. 2020, https://www.washingtonpost.com/politics/2020/04/10/4-reasons-coronavirus-is-hitting-black-communities-so-hard/. Accessed 10 Apr. 2020.

  13. Maybank, Aletha. “The Pandemic’s Missing Data.” The New York Times, 7 Apr. 2020, https://www.nytimes.com/2020/04/07/opinion/coronavirus-blacks.html. Accessed 13 Apr. 2020.

  14. “Senator Warren Introducing Bicameral Legislation to Require Federal Government to Collect and Report Coronavirus Demographic Data -- Including Race and Ethnicity.” Press Release, The Office of Senator Elizabeth Warren, 14 Apr. 2020, https://www.warren.senate.gov/newsroom/press-releases/senator-warren-introducing-bicameral-legislation-to-require-federal-government-to-collect-and-report-coronavirus-demographic-data_--including-race-and-ethnicity. Accessed 15 Apr. 2020.

  15. “Harris Pushes to Combat Racial Health Disparities Amid COVID-19 Crisis.” Press Release, The Office of Senator Kamala Harris, 14 Apr. 2020, https://www.harris.senate.gov/news/press-releases/harris-pushes-to-combat-racial-health-disparities-amid-covid-19-crisis_. Accessed 15 Apr. 2020.